This disclosure relates to a method and apparatus for rehabilitation of a patient with movement or neurological disorders attendant to strokes, Parkinson's disease, Huntington's disease, Alzheimer's disease and the like. The invention finds particular application in using a bike system with a controller to sense, control and dynamically alter a rehabilitation program for a patient with Parkinson's disease. While the invention herein will be described with particular reference to Parkinson's disease, it will be readily appreciated that it is relevant to treatment of those conditions just mentioned.
Parkinson's disease (PD), which affects approximately one million people in the US and 7 to 10 million people worldwide, is a chronic, progressive neurological disorder that is characterized by the loss of dopaminergic neurons in the brainstem. The main symptoms of the disease are movement disorders, and include shaking or tremor, muscle stiffness and rigidity, and slowness of physical movements (i.e., bradykinesia). As PD progresses, the combined motor and non-motor symptoms often lead to reduced independence and increased reliance on caregivers and the healthcare system. The economic impact of PD, including treatment, social security payments, and lost income from inability to work, is estimated up to $25 billion per year in the United States.
There is no known cure for this degenerative disease that results in progressive deterioration of motor skills along with other reduced physical and mental functions. The accepted treatment for PD is medication (e.g. levodopa) and in some cases surgical intervention (e.g. deep brain stimulation). These treatments only mask the symptoms and do not slow progression of the disease. Furthermore, they often have undesirable side effects, are costly and can introduce additional health risks. Considering these deficiencies, there is a need for innovative treatments to prevent, delay disease progression, and improve the symptoms of PD.
Recent studies have shown that exercise and movement therapies have significant benefits for individuals with PD, but there is little consensus on the optimal mode or intensity. Several studies have documented the benefits of high-cadence tandem cycling for motor function improvement in PD riders. However, the effective factors of exercise (e.g., rpm, intensity, intervention type, duration of the exercise, and the like), which constitute an optimal exercise intervention for PD patients, are still unknown. For example, each PD patient has different symptoms and skill levels, which makes it challenging to design a general rehabilitation system that gives the maximum benefit to all PD patients. Moreover, progression of the disease often requires re-assessments and modifications of the motor rehabilitation programs.
Several studies have shown a significant improvement in patient motor skills from tandem cycling. However, even with the exceptional results reported from tandem cycling, large-scale use of the tandem cycling paradigm for exercise therapy is not feasible for several reasons. First, tandem cycling requires an able-bodied trainer to assist in pedaling that is not reasonable in large-scale clinical deployment or in-home use. Second, variability in trainer pedaling speed, stamina, and response to the PD rider's performance creates variations that make data analysis and conclusions in clinical studies difficult to generalize. Third, there are a number of factors, such as cadence, foot position and workload that can affect the biomechanics of cycling and resultant performance. Many motorized single-rider stationary exercise bikes are commercially available today that can provide a pre-programmed load profile for the rider. However, it has not been possible to reproduce the dynamics of the tandem bike cycling paradigm using currently available motorized cycles.